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. 2012 Jun;97(6):2068-76.
doi: 10.1210/jc.2011-2721. Epub 2012 Apr 6.

The association of fasting insulin, glucose, and lipids with bone mass in adolescents: findings from a cross-sectional study

Debbie A Lawlor  1 , Naveed Sattar, Adrian Sayers, Jon H Tobias
Affiliations

The association of fasting insulin, glucose, and lipids with bone mass in adolescents: findings from a cross-sectional study

Debbie A Lawlor et al. J Clin Endocrinol Metab. 2012 Jun.

Abstract

Context: It is unclear whether variation in insulin resistance mediates the positive association of fat mass with bone mass in children/adolescents.

Objective: Our objective was to examine whether markers linked to insulin resistance [fasting insulin, glucose, triglycerides, and high-density lipoprotein cholesterol (HDLc)] are associated with bone mass in adolescents, and if they are, to examine whether they mediate the fat mass-bone mass association.

Design and setting: We conducted a cross-sectional analysis in participants from the Avon Longitudinal Study of Parents and Children.

Participants: Participants included 2305 (1100 male) individuals of mean age 15.5 yr.

Outcome measures: We evaluated total body less head bone mineral content (BMC) (grams), bone area (BA) (square centimeters), and bone mineral density (BMD) (grams per square centimeter) from a dual-energy x-ray absorptiometry scan.

Results: Fat mass, fasting insulin, and triglycerides were positively associated with BMD, BMC, and BA; HDLc was inversely associated with these outcomes. For example, the adjusted mean difference in BMC per 1 sd fasting insulin was 45 g (95% confidence interval = 17-73 g) in males and 50 g (95% confidence interval = 28-72 g) in females. When the associations of fat mass with outcomes were adjusted for markers of insulin resistance, they were largely unchanged. Associations of triglycerides and HDLc with outcomes were attenuated to the null when they were adjusted for fat mass, whereas those of insulin changed direction; i.e. with adjustment for fat mass, higher fasting insulin was associated with lower BMD, BMC, and BA.

Conclusions: Fasting insulin, glucose, and lipids do not appear to mediate the positive association of fat mass with bone mass in children/adolescents. The inverse association of fasting insulin with BMD, BMC, and BA once fat mass has been controlled for needs further study.

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Figures

Fig. 1.
Fig. 1.
Participant flow.
Fig. 2.
Fig. 2.
Hypothesized causal relationships being examined. Solid lines represent associations for which there is good evidence of causality (see text). The dashed line represents the key associations being tested in this paper. If associations are found between fasting insulin and associated markers and bone mass, these may mediate some or all of the association between fat mass and bone mass. That is the total association of fat mass with bone mass (A plus B) would be attenuated upon adjustment for fasting insulin and associated markers. If all of the association was mediated (i.e. all via A), then attenuation would be to the null. If it was only partially mediated, then some association would remain (represented by B). Furthermore, an association of fasting insulin and associated markers with bone mass might be confounded by fat mass, because this is related both to fasting insulin and associated markers (A) and bone mass (B). If this association is fully confounded, adjustment for fat mass would result in attenuation to the null.
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